When is a prospective audit performed?

A prospective audit is performed before the submission of claims. This type of audit aims to assess and ensure the accuracy, legitimacy, and compliance of medical documentation and coding before any claims are submitted to insurance companies. By conducting this audit ahead of claim submission, healthcare practices can identify any potential issues or discrepancies in documentation and coding, allowing for corrections to be made proactively. This not only improves the likelihood of claim approval but also helps in adhering to regulatory guidelines and reducing the risk of audits or denials after submission.

This approach contrasts with retrospective audits, which occur after claims have been submitted, reflecting on past actions rather than enhancing current practices. The timing of the audit is essential, as it allows healthcare providers to make informed decisions based on accurate documentation before they engage in the claims process.